1. I feel dirty, like there's something wrong with me. all the time
2. Sometimes I think I'm crazy. sometimes
3. I feel ashamed. all the time
4. I'm different from other people. all the time
5. I feel powerless. all the time
6. If people really knew me, they'd leave. never
7. I want to die. sometimes
8. I want to kill myself. sometimes
9. I hate myself. all the time
10. I have a hard time taking care of myself. all the time
11. I don't deserve to be happy. sometimes
12. I don't trust my intuition or my feelings. never
13. I'm often confused. sometimes
14. I don't know how to set goals and follow through on them. sometimes
15. I'm scared of success. sometimes
16. I'm a failure. I don't feel capable of doing a good job. sometimes
17. I use work to make up for empty feelings inside. never
18. I'm a perfectionist. never
19. I've made up a lot of stories about my life. sometimes
20. I've done a lot of shoplifting. ya
MY FEELINGS
1. I don't think feelings are very important. No
2. I usually don't know what I'm feeling. sometimes
3. I can't tell one feeling from another. Never
4. I only experience one or two emotions. no
5. I have a hard time expressing my feelings. no
6. I have a hard time crying freely. no
7. I cry all the time. all the time
8. I get uncomfortable when I feel too happy. ya
9. I get nervous when things are relaxed and calm. ya
10. I feel enraged a lot of the time. no
11. I'm rarely angry. Anger scares me. yes
12. I get depressed a lot. yes
13. I have a lot of nightmares. yes
14. I have panic attacks. yes
15. If I really let myself go, my feelings would be out of control. yes
16. I've been violent. no
17. I haven't been violent yet, but I'm worried I might be. no
MY BODY
1. I'm not "in my body" a lot of the time. true
2. I frequently space out. yes
3. My body often feels numb. yes
4. I feel as if my body is separate from the rest of me.
yes
5. I don't pay too much attention to my body's signals (hunger, tiredness, pain). yes
6. I think my body is ugly.
yes
7. I hide my body. yes
8. I'm dyslexic. I had learning disabilities when I was growing up. no
9. I use drugs or alcohol more than I think I should. yes
10. I often eat compulsively. yes
11. I keep myself from eating, or eat and throw up. sometimes
12. I hurt myself on purpose (cut, burn or injure myself)
sometimes
13. I have illnesses I think are related to my abuse. no
14. I've worked out to make my body strong so I wouldn't feel like a victim. no
15. I've had flashbacks of the abuse during surgery or other medical procedures. no
16. I'm scared to go to the dentist. I hate the feeling of things in my mouth. yes
17. (For women) I'm scared to go to the gynecologist. yes
INTIMACY
1. I often feel alienated from other people, as if I'm from another planet. yes
2. Most of my relationships just don't work. yes
3. I don't have many friends. true
4. I'm okay with my friends, but I just can't work things out with a lover. no
5. I think I'm really meant to be alone. yes
6. I'm not sure I deserve to be loved. yes
7. I don't know what love is. no
8. I find it hard to trust people. yes
9. I think people are going to leave me. yes
10. I test people a lot. yes
11. It's hard for me to be nurtured or to nurture someone else. yes
12. I'm clingy with people I'm close to. I'm afraid to be alone. yes
13. I'm scared of making commitment. When people get too close, I panic. yes
14. I have a hard time saying no. no
15. People take advantage of me in relationships. yes
16. I get involved with people who are inappropriate or inaccessible. yes
17. I've had relationships with people who remind me of my abuser. yes
18. I'm struggling a lot with my partner. no
19. Sometimes I think my partner is my abuser. no
20. Sexual abuse is really creating problems in my relationship. no
SEXUALITY
1. I avoid sex. Deep down, I wish I never had to deal with sex again. yes
2. I am celibate. I haven't had sex in years.
3. I really think sex is disgusting. no
4. I don't feel sexual desire. I think there's something basically wrong with it. yes
5. Sex isn't pleasurable for me. I usually have sex to make the other person happy. yes
6. I try to use sex to meet most of my needs. no
7. It really feels like I'm "oversexed" no
8. Sex and aggression are really connected for me. no
9. I find it hard to be close in nonsexual ways. It just isn't satisfying. no
10. I frequently go after sex I really don't want. no
11. Sex is the thing I'm best at. no
12. I've sold myself for sex. no
13. I've had sex with people who don't respect me. no
14. I need to control everything about sex. no
15. I have a hard time staying present when I make love. I'm numb a lot during lovemaking. yes
16. When I am sexual, I have terrifying, scary feelings I don't understand.
yes
17. I often have flashbacks of my abuse while making love.
yes
18. I get sexually aroused when I read or talk about sexual abuse. no
19. Violent, sadistic fantasies turn me on. no
20. I'm ashamed of my sexuality. no
21. I've sexually abused others. no
CHILDREN AND PARENTING
1. I feel awkward and uncomfortable around children. no
2. I have a hard time being affectionate with kids.
3. I have a hard time setting boundaries with kids.
4. I have a hard time balancing children's needs with my own.
5. (For parents) I feel inadequate as a parent.
6. I have trouble protecting children I take care of.
7. I tend to be overprotective.
8. I've successfully protected children.
9. I'm scared I'll be abusive.
10. I have abused children.
11. My kids have been abused (by someone else).
MY FAMILY OF ORIGIN
1. I have strained relationships with my family. yes
2. Members of my family have rejected me (or vice versa)no
3. I have a hard time setting limits with my family. yes
4. People in my family invalidate my feelings and experiences. no
5. I feel crazy when I'm around my family. yes
6. I can't be honest with the people in my family. yes
7. My abuse is still a secret in my family. no
8. I'm waiting for people in my family to come around and support me. no
If many of the statements on this list were familiar to you, you may feel overwhelmed right now. Put the purpose of this assessment is not to overwhelm you; it's to show you that there's a reason why you experience the things you do. It's to point out the areas that need healing. It is possible to dramatically alter your life so that your answers two years from now will bear little resemblance to your answers today.
1. When I look over my responses, I feel... scared
anyone who can help please email me

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